A 31 year old primipara at full term delivered a healthy baby vaginally, following an uncomplicated labor. The placenta was delivered completely, following which prophylactic oxytocin was administered. An episiotomy was not performed. When reassessed 30 minutes after delivery, she was found to be bleeding heavily. Her pregnancy had been uneventful, and her medical and surgical histories were unremarkable.
Blood group: A+ve 4 pints of blood cross-matched
INR: 1.0 (normal: 0.9 - 1.3) APTT: 32s (normal: 24 - 35 in third trimester) TT: 14s (normal: 13 - 15) S. Fibrinogen: 300 mg/dl (normal: 200 - 400)
WBC/DC: 6,300/mm3 Hb: 9.7 mg/dl Platelets: 330,000/mm3
There is no evidence of retained intrauterine tissue. There is no free fluid in the abdomen.